• Anila Rashid Aga Khan University Hospital Karachi
  • Huma Mansoori Dow University of health sciences Karachi
  • Sidra Asad Ali The John Curtin School of Medical Research, The Australian National Unversity
  • Nabeel Nasir CMH Medical College and Institute of Dentistry Karachi



Background: Advances in imaging techniques and longer survival of chronic medical conditions contribute to the increase in paediatric thrombosis. We aim to determine the incidence, underlying risk factors, management and clinical outcome of paediatric thrombosis at a multidisciplinary facility of Pakistan. Methods: A retrospectively analysis of the medical records of patients in the paediatric age group admitted at the Aga Khan University hospital from January 2013-September 2018 was performed. Site of thrombosis, associated risks factors, management options and outcome of thrombotic event were evaluated. Results: Of the 22,320 paediatric hospitalization, 35 paediatric patients were diagnosed with thrombosis (15 cases per 10,000 admissions). The median age of the study group was 15 years and twenty patients (57%) were male. The commonest site of thrombosis was in lower limb venous 11 (31%), followed by upper limb venous thrombosis 6 (17%), abdominal vein thrombosis 7 (20%), cerebral venous thrombosis 5 (14%), pulmonary embolism and arterial thrombosis 3(9% each). Eighty three percent had underlying clinical condition including central venous catheter [CVC] (26%), malignancy and infection (14% each), antiphospholipid antibody syndrome (9%), inherited thrombophilia (9%), congenital heart disease (6%), while thrombotic thrombocytopenic purpura and autoimmune disorder (3% each). 12 (34%) patients were treated with heparin only, 8 (23%) received heparin followed by warfarin while warfarin as a single agent was given in 2 (5.7%) patients. One patient died of pulmonary embolism while 9(25%) had persistence or recurrence of thrombosis. Conclusion: Incidence of paediatric thrombosis was 0.15%. CVC placement was the most common associated risk factor. Warfarin and heparin both were found to be safe anticoagulation option. Recurrence rate was found to be high

Author Biographies

Anila Rashid, Aga Khan University Hospital Karachi

Assistant Professor, Department of Pathology and Laboratory Medicine

Huma Mansoori, Dow University of health sciences Karachi

Assistant Professor, Department of Pathology

Sidra Asad Ali, The John Curtin School of Medical Research, The Australian National Unversity

PHD student, ACRF department, Cancer Biology and Therapeutics

Nabeel Nasir, CMH Medical College and Institute of Dentistry Karachi

MBBS Student


Chan AK, Monagle P. Updates in thrombosis in paediatrics: where are we after 20 years? Hematology Am Soc Hematol Educ Program 2012;2012:439–43.

van Ommen CH, Heijboer H, Buller HR, Hirasing RA, Heijmans HS, Peters M. Venous thromboembolism in childhood: a prospective two-year registry in The Netherlands. J Pediatr 2001;139(5):676–81.

Chalmers EA. Epidemiology of venous thromboembolism in neonates and children. Thromb Res 2006;118(1):3–12.

S Revel-Vilk , A Chan, M Bauman, P Massicotte. Prothrombotic conditions in an unselected cohort of chidren with venous thromboembolic disease. J Thromb Haemost 2003;1(5):915–21.

Audu CO, Wakefield TW, Coleman DM. Paediatric deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2019;7(3):452–62.

Wright JM, Watts RG. Venous thromboembolism in paediatric patients: epidemiologic data from a paediatric tertiary care center in Alabama. J Pediatr Hematol Oncol 2011;33(4):261–4.

Nowak-Göttl U, Janssen V, Manner D, Kenet G. Venous thromboembolism in neonates and children-update 2013. Thromb Res 2013;131(Suppl 1):S39–41.

Choi HS, Choi CW, Kim HM, Park HW. Venous thromboembolism in paediatric patients: a single institution experience in Korea. Blood Res 2016;51(3):164–70.

White RH, Keenan CR. Effects of Race and Ethnicity on the Incidence of Venous Thromboembolism. Thromb Res 2009;123(Suppl 4):S11–7.

Julie Jaffray , Guy Young. Deep Vein Thrombosis in Paediatric Patients. Pediatr Blood Cancer 2018;65(3).

Naheed F, Kammeruddin K, Tufail A, Baillie P, Hussain A. Evaluation of risk factors for venous thrombo-embolism and thrombo-prophylaxis with unfractionated heparin in post operative gynaecological patients. J Surg Pak 2008;13(3):95–8.

Rathore MF, Hanif S, New PW, Butt AW, Aasi MH. Khan SU (2008) The prevalence of deep vein thrombosis in a cohort of patients with spinal cord injury following the Pakistan earthquake of. Spinal Cord 2005;46(7):523–6.

Newall F, Wallace T, Crock C, Campbell J, Savoia H, Barnes C, et al. Venous thromboembolic disease: a single-centre case series study. J Paediatr Child Health 2006;42(12):803–7.

Setty BA, O'Brien SH, Kerlin BA. Paediatric venous thromboembolism in the United States: a tertiary care complication of chronic diseases. Pediatr Blood Cancer 2012;59(2):258–64.

Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of central venous access devices: a systematic review. Paediatrics 2015;136(5):e1331–44.

Klaassen ILM, van Els AL, van de Wetering MD, van Ommen CH. Increasing incidence and recurrence rate of venous thromboembolism in paediatric oncology patients in one single centre over 25 years. Thromb Haemost 2017;117(11):2156–62.

Schmidt M, Horvath-Puho E, Thomsen RW, Smeeth L, Sørensen HT. Acute infections and venous thromboembolism. J Intern Med 2012;271(6):608–18.

Silvey M, Brandão LR. Risk factors, prophylaxis, and treatment of venous thromboembolism in congenital heart disease atients. Front Pediatr 2017;5:146.

Tormene D, Fortuna S, Tognin G, Gavasso S, Pagnan A, Prandoni P, et al. The incidence of venous thromboembolism in carriers of antithrombin, protein C or protein S deficiency associated with the HR2 haplotype of factor V: a family cohort study. J Thromb Haemost 2005;3(7):1414–20.

Ma J, Song H, Wei M, He Y. Clinical Characteristics and Thrombosis Outcomes of Paediatric Antiphospholipid Syndrome: Analysis of 58 Patients. Clin Rheumatol 2018;37(5):1295–303.

Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e737–801.

Goldenberg NA, Takemoto CM, Yee DL, Kittelson JM, Massicotte MP. Improving evidence on anticoagulant therapies for venous thromboembolism in children: key challenges and opportunities. Blood 2015;126(24):2541–7.